Jacqueline Mary Henretig, is a medicare enrolled "Psychologist - Clinical" provider in Tempe, Arizona. Her current practice location is
1840 E Broadway Rd, Tempe, Arizona. You can reach out to her office (for appointments etc.) via phone at
(022) 437-2776.
Jacqueline Mary Henretig is licensed to practice in Arizona (license number PSY-005432) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1316372139.
Healthcare Provider's Profile
Full Name | Jacqueline Mary Henretig |
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Gender | Female |
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Speciality | Psychologist - Clinical |
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Location | 1840 E Broadway Rd, Tempe, Arizona |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1316372139
- Provider Enumeration Date: 09/11/2013
- Last Update Date: 08/05/2021
Medicare PECOS Information:
- PECOS PAC ID: 0648676056
- Enrollment ID: I20210910000982
Medical Identifiers
Medical identifiers for Jacqueline Mary Henretig such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1316372139 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
103TC0700X | Psychologist - Clinical | PSY-005432 (Arizona) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacqueline Mary Henretig allows following entities to bill medicare on her behalf.
Entity Name | Sondermind Provider Network Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20210318002844 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacqueline Mary Henretig is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jacqueline Mary Henretig, 3003 N Central Ave Ste 1600, Phoenix, AZ 85012-2908 Ph: (602) 323-3492 | Jacqueline Mary Henretig, 1840 E Broadway Rd, Tempe, AZ 85282-1614 Ph: (022) 437-2776 |
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